Provider Demographics
NPI:1346573623
Name:HASAN, ANISUL
Entity Type:Individual
Prefix:MR
First Name:ANISUL
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7619
Mailing Address - Country:US
Mailing Address - Phone:718-941-2669
Mailing Address - Fax:718-941-0935
Practice Address - Street 1:1242 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7619
Practice Address - Country:US
Practice Address - Phone:718-941-2669
Practice Address - Fax:718-941-0935
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist